Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Useful Ultrasound Findings of Pediatric Patients with Equivocal Results of Appendicitis: Analysis Based on a Structured Report Form

애매한 초음파 결과를 보인 소아 환자에서 충수돌기염을 감별하는데 유용한 초음파 소견: 구조화 판독문에 기초한 분석

  • Jiyoung Choi (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Hyuk Jung Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Suk Ki Jang (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Hyun Jin Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Jae Woo Yeon (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital)
  • 최지영 (분당제생병원 영상의학과) ;
  • 김혁중 (분당제생병원 영상의학과) ;
  • 장석기 (분당제생병원 영상의학과) ;
  • 김현진 (분당제생병원 영상의학과) ;
  • 연재우 (분당제생병원 영상의학과)
  • Received : 2019.12.11
  • Accepted : 2020.05.07
  • Published : 2021.01.01
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Abstract

Purpose To identify the features that can be used for differentiating appendicitis from non-appendicitis in pediatric patients with equivocal ultrasound (US) results. Materials and Methods A total of 53 pediatric patients (≤ 18 years old) with equivocal results on US examination for suspected appendicitis between November 2012 and October 2017 were included. US evaluation was conducted based on information retrieved from a predefined structured report form. Then, the likelihood of appendicitis was prospectively classified into five categories. The equivocal results were considered as grade 3 (indeterminate) and grade 4 (probably appendicitis). Results Of the 53 patients, 25 (47.2%) and 28 (52.8%) were classified into grade 3 and 4 groups, respectively. Among the individual US findings, increased vascularity of the appendiceal wall and peri-appendiceal fat infiltration were independent findings associated with the diagnosis of appendicitis (p = 0.005, p = 0.045, respectively) in the multivariate logistic regression analysis and showed the highest diagnostic accuracy (69.8% and 62.3%, respectively). Conclusion Increased vascularity within the appendiceal wall and peri-appendiceal fat infiltration were significant predictors of appendicitis in patients with equivocal US findings.

목적 애매한 초음파 결과를 보인 소아 환자들에서 충수돌기염을 감별하는 데 도움이 되는 초음파 소견들을 알아보고자 한다. 대상과 방법 2012년 11월부터 2017년 10월 사이에 충수돌기염이 의심되어 초음파를 시행한 소아 환자 중 애매한 결과를 보인 53명의 환자를 대상으로 하였다. 초음파 검사는 정해진 구조화 판독문을 사용했으며 충수돌기염의 가능성은 5가지로 분류되었다. 그중 3등급과 4등급을 애매한 결과로 간주하였다. 결과 53명의 환자 중 각각 25명(47.2%)과 28명(52.8%)이 3등급과 4등급으로 분류되었다. 각 초음파 소견 중 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤이 충수돌기염을 진단하는 데 다변량 로지스틱 회귀분석에서 의미 있는 소견이었고(p = 0.005, p = 0.045), 진단적 정확도도 높았다(69.8%, 62.3%). 결론 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤은 애매한 초음파 결과를 보인 소아 환자들에서 의미 있는 충수돌기염의 예견 인자이다.

Keywords

Acknowledgement

This research was supported by grants from the Central Medical Service. Co., Ltd. (DMC 2018-11-007-001).

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